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HomeMy WebLinkAbout123895 CITY OF GLENDALE ki41). PLANNING&DEVELOPMENT SERVICES 5850 W.GLENDALE AVE.,2ND FLOOR GLENDALE,AZ 85301 OWNER/BUILDER ADDENDUM Glendale 623.930.2800 ARIZONA www.GlendaleAZ.com RESIDENTIAL PROJECTS ONLY DATE: o ZA/2 0 Z COG PERMIT NUMBER:PROJECT ADDRESS: o I^ C' PROJECT NAME: r)C cN Oi q Z GQ M Z L /Jt^L �` (� 11 r 62_LlZ l/U acii(c) LAJ FooL The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statutes Title 32,Chapter 10, on the asis 9f: ARS 32-1121.A.5 The applicant owns the property and shall occupy the property,and does not intend the property to be for sale or rent,and shall have the work performed by the applicant alone,or by the applicant with employees of the applicant,and/or performed by duly licensed contractor(s)all of whom are identified below or on the attached. ARS 32-1121.A.6 The applicant owns the lu❑ pp' p petty and shall have the work performed only by duly licensed contractor(s)ail of whom are identified below or on the attached. CONTRACTOR/COMPANY NAME: AZ ROC NUMBER: LICENSE CLASSIFICATION: ❑ ARS 32-1121.A.7 The applicant is registered architect or engineer,or employee of registered architect or engineer engaged in professional practice,not as a contractor. The undersigned swears and affirms that the information herein is true and accurate,and acknowledges that the filing of an application containing false or incorrect information with the intent to avoid licensing or tax requirements of the State of Arizona is"unsworn falsification",a criminal misdemeanor. PRINTED NAME OF THE OWNER: SIGNATURE OF THE OWNER: DATE: r 601 S 0 r'/I Z GOf�ez, oz7fD /LoZw 1a3 295 This review shah .iut pr ent the Budding 1;• Official from thereafter requiring the correction d errors .n said plans, specifications, data and arutructior when in violation of any codes or Glendale ordinances it rffect REVIEWED FOR CODE COMPLIANCE i I By Building Safety Divit;on, car d POOL GLEr.DALF, ASWIMMING q,q , BARRIER AFFIDAVIT tom: �LAI Ordinance#2046 1 Dir Please tine o mint• Date 0a /1 /2D20 Property Address 6 2 `-I Z • 0rz.c 1 LA) Name of Property Owner 061 19, ,12_ I. - No children less than six years of age reside at this address. II. X A child under the age of six years of age resides at this address. (If this box is checked, identify method of secondary pool protection.) A. _ We will provide an interior fence and enclosure around the pool as required by the Glendale Pool Barrier Ordinance. B. _ We will provide exterior fence and enclosure protection with secondary protection as checked on reverse side of this affidavit per the Glendale Pool Barrier Ordinance. oote� ter*., -e of (Complete IerseSide)i imam,'' Ji ave:t "I ;uS a£-or asx}ti3 aF;�xgt.o+M rwi rxno3 City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599 Phone(623)930-2800•www.glendaleaz.com 0 Glendale ❑ 1. The pool shall be protected by a motorized safety pool cover. V 2. Doors and windows protected. ❑ 3. The pool shall be protected by an alarm maintained in or on the swimming pool. ❑ 4. The above ground swimming pool shall have a ladder secured. ❑ 5. Locking hard safety cover on the spa or hot tub. ❑ 6. Alternative protection not specified above which is attached to the plan submittal and submitted for approval by the building official. 2c Oc, 'y5 0412 C,ro'b, z 477 l ©z/ 1zo Name of Home Ov#ner(Print) Home Owner Signature Date 0,OW t"!(:3 0-ev V-ys1A Pool Contractor(Print) Contractor Signature Date SIGNATURE OF OWNER MUST BE NOTARIZED State of Arizona County of Maricopa On this day of -}fsb(j Y , 2020 , before me personally appeared .jam , Q S D102 v 7 (name of signer), whose identity was proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to in this document, and who acknowledged that he/she signed the above/attached document. Nmboti.lonot arm Notary P*Is , � .i ( Mrloops County.A one • My Comm.Swim 10-90-20 23 Wj1Mi1. (e/ ..,. - (Seal) Commission No.572 Notary Public City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599 Phone(623)930-2800•www.glendaleaz.com